| NPI | 1942533104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12596-24) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| 2251X0800X Physical Therapist, Orthopedic | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2014-07-22 |